Preemptive DAAs offer a safer approach for HCV+ heart transplant

  • Bethea ED & al.
  • Lancet Gastroenterol Hepatol
  • 25 Jul 2019

  • International Clinical Digest
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Takeaway

  • Initiating direct-acting antivirals (DAAs) before transplant, rather than after, hastens viral suppression and yields excellent outcomes with HCV+ donor hearts.

Why this matters

  • Another recent study (DONATE HCV, n=44) has reported positive results with sofosbuvir/velpatasvir (Epclusa) in HCV+ heart/lung transplants.
  • Pangenotypic regimens such as glecaprevir/pibrentasvir (GLE/PIB, Mavyret) are favored and also avoid sofosbuvir-based drug interactions.

Study design

  • 25 recipients of HCV+ hearts (mean age, 54 years; 72% male); 3 underwent simultaneous HCV+ kidney transplant.
    • Recipients of viremic hearts (n=20), as determined by nucleic acid testing (NAT), started preemptive GLE/PIB prior to surgery, continuing treatment for 8 weeks afterward.
    • Recipients of NAT-negative hearts (n=5) were observed for viremia and treated if necessary.
  • Funding: American Association for the Study of Liver Diseases, NIH, and Massachusetts General Hospital.

Key results

  • All 20 recipients of NAT-positive grafts achieved rapid HCV clearance; median, 3.5 (interquartile range [IQR], 0-8.3) days.
  • All 20 achieved sustained virologic response at 12 weeks posttherapy (SVR12).
  • Median peak recipient viral load was 409 (vs donors, 3.76 million) IU/mL.
  • No recipients of NAT-negative grafts developed viremia.
  • Patient and graft survival rates were 100% at a median follow-up of 10.7 (range, 6.5-18.0) months.
  • Median time to transplant was 20 (IQR, 8-57) days.

Limitations

  • Long-term outcomes unknown.

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